Practice-Based Evidence Goes Mainstream

For years, my colleagues and I have been using the phrase “practice-based evidence” to refer to clinicians’ use of real-time feedback to develop, guide, and evaluate behavioral health services. Against a tidal wave of support from professional and regulatory bodies, we argued that the “evidence-based practice”–the notion that certain treatments work best for certain diagnosis–was not supported by the evidence.

Along the way, I published, along with my colleagues, several meta-analytic studies, showing that all therapies worked about equally well (click here to access recent studies children, alcohol abuse and dependence, and post-traumatic stress disorder). The challenge, it seemed to me, was not finding what worked for a particular disorder or diagnosis, but rather what worked for a particular individual–and that required ongoing monitoring and feedback. In 2006, following years of controversy and wrangling, the American Psychological Association, finally revised the official definition to be consistent with “practice-based evidence.” You can read the definition in the May-June issue of the American Psychologist, volume 61, pages 271-285.

Comments

Hi Scott-
It’s encouraging to see a psychiatrist like David Hellerstein endorsing the importance of collecting evidence from our own actual clients to determine whether we are really making a difference in our clients’ lives rather than relying on treatment guidelines and fantasizing that this is all we need to do. Unfortunately, while I share your hope about our field turning the corner, we have such a long way to go with many in the mainstream mental health culture.

A recent issue (Sept/Oct 2009) of The National Psychologist quoted the APA president, James Bray, as saying, “We have heard from the insurance industry and policy makers that we are shooting ourselves in the foot by not having treatment guidelines for psychotherapy…” While another leader emphasized linking guidelines with outcomes, we know from experience (and from that debate between Bruce Wampold and David Hollon) that for most in our field, “accountability” means using a treatment that in the hands of other clinicians and with other clients was helpful. And we know from the data that it simply isn’t anywhere near valid to do so. There is still a broad assumption that by “doing what the experts did” we can be assured of achieving similar outcomes. Wrong. The data have spoken: Know Thine Own Outcomes.

I like your comments! But I wanted to click on: ‘click here to access recent studies children, alcohol abuse and dependence, and post-traumatic stress disorder’, but I see there is no link. Can you fix it, please? It really interests me!
Thanks!

Thanks for sharing this recent movement towards practice based evidence. I find this news encouraging.

A long the lines of encouragement, in British Columbia, Canada the Ministry of Health and Service Providers for mental health & addiction are working out what types of data/information is required to assess, in part, how effective our services are to those we serve. The steering committee has apparently heard of Client-Directed Outcome Informed meta-model, but is not prepared to move on the adoption of the outcome measures, at this time. This is unofficial, and yet it is encouraging that they are considering alternative ways to determine how effective services are, and may consider a shift to inclusion of measures that reflect the client’s perspective.

A change in what we measure could have large implications for how funding gets streamed, how limited resources can target based on evidence of benefit. This would be huge, as you know our systems of health care often focuses on providing the wrong service to a small population of folks who really need assistance – but assistance with issues like housing, food, and safety as identified by them (client-directed), rather than being directed to detox, psychotherapy programs and associated psychiatric care – time and time again – with limited or insignificant results.

A recent movie, “The Soloist” had a scene where the director of a street shelter in LA told a well meaning Journalist/helper (Robert Downey, Jr) who wanted the main character (Jamie Foxx) to get diagnosed and the right medication/treatment, “Most of these people have had several diagnoses, where has it got them?”

Champions like yourself may influence, not policies and practices in the US but in Canada, as well. Keep up the good work, and getting the message out there.

What about all of those people that don’t have health insurance, are they included in any formula of this plan? I know people who are more tempted to go for private business insurance instead of relying on the health care system. Those who have addiction problems can’t make decisions for themselves, they are helpless if somebody doesn’t include them in any health plan.